Esophageal Duplication Cysts
Esophageal duplication cysts are rare congenital anomalies, although the esophagus is the second most common location for duplication in the gastrointestinal tract after the ileum. The cysts are most frequently located in the right posterior mediastinum at the level of the distal third of the esophagus.
The cysts are lined by squamous, columnar, cuboidal, pseudostratified, or ciliated epithelium. They are covered by two thick muscle layers that are in contiguity with the muscularis propria. They may occur with other congenital abnormalities such as esophageal atresia. Duplication may present with megaesophagus similar to achalasia due to obstruction at the gastroesophageal junction by the cyst. Rarely, cancer may develop in the cyst.
The most common presenting symptoms are dysphagia or respiratory symptoms (particularly in the proximal esophagus) due to esophageal and or tracheobronchial compression. Imaging is commonly performed through a combination of techniques, including endoscopy, endoscopic ultrasound (particularly when the cyst appears solid), computed tomography, and barium esophagography. The diagnosis can be made in utero, in childhood, or in adulthood. When found incidentally, no further treatment is needed. For patients with symptoms or complications, surgical excision is usually indicated.